As I prepare for retirement this month and reflect on my four years as the director of the neglected infectious diseases team here at the Bill & Melinda Gates Foundation, one of the things I am most proud of is to have been part of a global team that has been working to get a new Japanese encephalitis vaccine to the millions of people who need it.
Just over a decade ago, the Gates Foundation supported our grantee, PATH, to turn a little-known vaccine from China into an internationally approved tool to fight Japanese encephalitis, an incurable disease also known as “brain fever”.
Twenty-six countries in Asia and the western Pacific are still affected by mosquitoes carrying the Japanese encephalitis virus. If bitten, infected people can develop inflammation of the brain and experience a sudden onset of headache, high fever, disorientation, coma and convulsions. About 1 in 4 cases are fatal.
This week, Laos launched a nationwide Japanese encephalitis campaign aimed at reaching 1.5 million children. Laos is the first country to introduce the vaccine with the support of Gavi, the Vaccine Alliance, marking a new milestone in the Japanese encephalitis story.
The project began in 2003 when a team from PATH identified the safe, effective vaccine that has been used in China for more than 20 years and began working with the manufacturer, Chengdu Institute of Biological Products, the World Health Organization and ministries of health to conduct pivotal clinical trials to add to a growing collection of data on the vaccine.
In October 2013, thanks to the efforts of these partners to hasten the timeline for getting this lifesaving tool to the global market, a major milestone was reached: The WHO prequalified the new vaccine, a first for China. The vaccine is illustrative of China’s emerging role as a leader in research and development for health products that can have a significant impact in reducing disease and improving quality of life in developing countries.
The new vaccine is now available to the world’s poorest countries for a fraction of the price of other vaccines on the market and is expected to reach an estimated 290 million children outside of China by 2017. It’s a fantastic example of what can be achieved in expanding affordable access to health in developing countries when partners work together to address the needs of the world’s poorest.
While it took persistence to get to this introduction in Laos this week, I believe the redevelopment of this vaccine has been very successful and there have been many great successes along the way.
Even before WHO prequalified the new vaccine in 2013, six endemic countries had approved and introduced the vaccine. Low public sector prices, extending beyond Gavi-eligible countries, are the direct result of global access commitments required of all our grantees. For instance, since Nepal began using the new vaccine to protect children in their highest-risk districts in 2006, the country has seen a 72 percent decrease in cases of the disease.
Perhaps most notable is the impact that followed India’s 2005 decision to introduce the vaccine. From 2006 to 2014, India purchased over 220 million doses of the vaccine from CDIBP for initial vaccination campaigns of children less than 15 years followed by routine childhood vaccination.
Within weeks of WHO prequalification, the Gavi board swiftly approved the opening of a funding window to support Japanese encephalitis vaccination catch-up campaigns for young children. Our investments continue to support the remaining high-burden countries’ efforts to introduce, expand or improve programs and we anticipate that this introduction will be complete by 2020.
The Japanese encephalitis project has also had a very positive impact on CDIBP’s manufacturing capacity, supplying both the domestic Chinese and export markets. There has been a 180 percent increase in CDIBP’s annual production capacity as a result of their newly constructed facility. The anticipated average number of vaccine doses exported internationally by CDIBP in 2013-2017 from the new production facility (roughly 45 million doses per year) is a 260 percent increase over the annual average for 2003-2011 (17 million doses per year). The new facility also produces 20 million doses per year to protect Chinese children from the disease.
There remains work to be done to make sure all communities have access to this lifesaving vaccine, but thanks to the steadfast commitment from our partners we are much, much closer to a world where families can live without fear of brain fever. I am grateful to the Bill & Melinda Gates Foundation and our deep bench of partners to have played even a small part in this historic moment for global health.
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